Provider Demographics
NPI:1548209042
Name:ECHEVERRIA, JUANA ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:JUANA
Middle Name:ELIZABETH
Last Name:ECHEVERRIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8755
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8755
Mailing Address - Country:US
Mailing Address - Phone:787-852-8964
Mailing Address - Fax:787-257-2665
Practice Address - Street 1:JESUS FRAGOSO AVENUE HWY # 3 LOIZA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-752-9200
Practice Address - Fax:787-257-2665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57118ECOtherTRIPLE S
PR6720002OtherHUMANA PUERTO RICO